Wu Jing, Director of Chronic Disease Prevention and Community Health Department at Chinese CDC: Chronic Disease Control Has Become a National Priority, with Grassroots Management Facing Daunting Challenges

From May 17 to 18, the “2017 China Primary Healthcare Innovation Practice Forum” was held in Chengdu. The conference explored development trends in the primary healthcare industry from perspectives including industrial policy, technological evolution, business models, and industrial collaboration. It brought together professionals from across the sector to participate in keynote speeches, roundtable discussions, and other activities.We have compiled the stenographic notes from the guests’ on-site presentations for reference by industry professionals.The conference has invitedWu Jing, Director of the Division for Chronic Disease Prevention and Control and Community Health at the Chinese Center for Disease Control and Prevention, delivered a speech titled “Where to Begin in Enhancing Chronic Disease Management Capabilities in Primary Healthcare Institutions.”Below is a summary of the guest speakers’ presentations compiled by VCBeat (WeChat ID: vcbeat).

How to Enhance Chronic Disease Management in Healthcare Institutions: A Challenging Question to Answer.

Six Shifts in Chronic Disease Management: Over the past few decades, China’s chronic disease management has undergone six significant transformations, integrating international and domestic experience with continuous local explorations—

First, chronic disease management has shifted from being an advocacy effort by individual experts to a systematic government-led initiative;

Second, there is a greater emphasis on the shift from treatment to prevention;

Third, transitioning from hospital-centric healthcare delivery to models centered on primary care institutions and medical consortia;

Fourth, chronic diseases were once considered “diseases of affluence,” predominantly affecting urban populations; however, the current situation in rural areas is increasingly severe, prompting a shift in chronic disease management from an urban-centric model to one encompassing both urban and rural regions.

Fifth, chronic disease prevention and control has gradually evolved into a whole-of-society effort involving all sectors, shifting from a health-sector-led approach to collaborative action across society;

Sixth, gradually transform chronic disease management into a practice that combines professional initiatives with public engagement.

Strengthened Policy Drivers for National Chronic Disease Management: To translate the concept of chronic disease prevention and control into action, policy serves as a critical driver and influential force. Internationally,Although China rarely publicizes its efforts in the prevention and control of chronic diseases, it actually ranks among the top in many areas.For instance, following the United Nations High-level Meeting on the Prevention and Control of Non-communicable Diseases, China became the first country to launch a national plan for NCD prevention and control. The "China National Plan for NCD Prevention and Control (2012–2015)," issued in May 2012, was jointly released by 15 ministries and commissions; meanwhile, local action plans in certain provinces involved as many as 23 departments, underscoring that NCD prevention and control requires multi-sectoral collaboration due to the complexity of implementation.

From March last year to the period of this year’s Two Sessions, a large number of programmatic documents on health and healthcare development were intensively issued. What does this indicate? First, health has been elevated to the level of national strategy; second, it demonstrates that the policy framework for health is becoming increasingly comprehensive.

The “Medium- and Long-Term Plan for the Prevention and Control of Chronic Diseases in China (2017–2025)” is the most recent guiding document on chronic disease prevention and control. Issued by the General Office of the State Council rather than led by 15 ministries and commissions, this document underscores the heightened priority accorded to chronic disease prevention and control at a higher administrative level. Its content is comprehensive, emphasizing approaches to chronic disease prevention and control from the perspectives of system development and technological advancement. Notably, the document highlights the encouragement of participation by non-governmental sectors, representing a significant breakthrough attributable to the summary and refinement of China’s years of practical experience in chronic disease prevention and control.

But where does the most critical implementation of chronic disease prevention and control policies lie? It still lies with people.

The entire healthcare industry, particularly primary care management, should start with two words:"Understanding". This was inspired by Mr. Bai Yansong, a “health advocate,” who delivered a remarkable speech titled “Why I Speak Up for Doctors: Because I Am ‘Not Foolish.’” What does “not foolish” mean? It means to “know,” to “comprehend,” and thereby to “understand.” Therefore, I believe that to effectively enhance chronic disease management, we must not only “understand” policies and the environment but also truly “understand” grassroots healthcare workers. Such understanding goes beyond perfunctory inquiries; it entails grasping who these chronic disease care professionals are, what they do, what they think, and what their needs are.

Therefore, since 2012, the Chinese Center for Disease Control and Prevention has established an eight-province cohort to conduct systematic longitudinal surveys of healthcare professionals engaged in chronic disease management at the primary care level, yielding several valuable conclusions.

1. Decreased Proportion of Chronic Disease Management Staff and Increased Workload: What is concerning is that, comparing the data from 2012 and 2015, we found thatChronic disease management has increasingly become a major priority in primary care, yet the proportion of professionals specializing in this field is declining, often falling below 30%.. This indicates that the workforce for chronic disease management at the primary care level is in urgent need of protection and strengthening. Moreover, the burden of chronic disease management at the primary care level continues to increase, placing higher demands on healthcare professionals. A team capable of managing 145 patients in 2012 might only be able to manage around 100 by 2015; in 2012, 62.58% of personnel reported feeling overworked, a figure that has now risen to 74.37%. Therefore, when designing related work protocols, the first priority should beTake into account the actual workload of staff.。

2. Achievements Made in Chronic Disease Management at the Primary Care Level: So, how effective is the management of patients with chronic diseases? In short,The results are highly significant., for instance, there has been a significant improvement in the control rate among patients with diabetes. This demonstrates that chronic disease management implemented at the primary community level is effective, and that longer duration of standardized management correlates with better disease control.

3. Demands of Primary Care Chronic Disease Management Personnel: We also surveyed the training content that primary-level chronic disease management personnel wish to receive. The results showed that the topics chronic disease workers hope to learn includePolicies and TechnologiesTwo aspects: the latest guidelines and performance metrics for chronic disease management, as well as specific procedures and precautions for treatment and medication. Another area of concern for primary healthcare professionals isLifestyle Guidance for Patients with Chronic Diseases, as there are approximately 8 million healthcare professionals nationwide, while the number of patients with chronic diseases is in the hundreds of millions. In many cases, patients need to proactively acquire skills for chronic disease management. In response, China has established a dedicated platform for the “National Healthy Lifestyle Action.” From 2017 to 2025, it will carry out the “Three Reductions and Three Improvements” special campaign, namely “reducing salt, oil, and sugar intake” and “promoting healthy weight, healthy oral health, and healthy bones.”

4. Dual Focus on Top-Level Design and Operational Models: In addition to addressing the aforementioned issues identified through our research, enhancing the chronic disease management capabilities of primary healthcare institutions requires a dual-pronged approach: first, strengthening top-level design; and second, studying proven models, such as the Sichuan model, the Shanghai model, and the Zhejiang model.

Finally, we must maximize the utility of the internet in chronic disease management, leveraging information technology to drive its advancement.